Life in the UK as a Foreign Doctor - UK Career Guidance for

International Medical Graduates

(Prepared by Dr Suresh K Pun)

Where to start?

In the United Kingdom (UK) you must be registered with the General Medical Council (GMC)
before being allowed to practice medicine. It is a GMC regulation that foreign doctors should
undertake the Professional and Linguistic Assessment Board (PLAB) before commencing any
NHS jobs or practising as a doctor in the United Kingdom.
The PLAB consists of two parts:
o PLAB part 1 is a theory exam where they will assess your clinical knowledge (200
EMQ or SBA questions- 3 hours from all the systems and subjects). Usually the pass
mark fluctuates from 125-130.
o PLAB part 2 is a clinical skills exam only conducted in Manchester and can only be sat
after passing PLAB 1. Here they judge you on your communication skills and also
whether you are a safe doctor to practise.
So all the foreign doctors need to take the PLAB, however, before that you need to have
either a passing International English Language Testing System (IELTS) band or an
exemption.
It is sensible to check with GMC or their website whether you fall under the exemption of
giving IELTS. If your degree teaching and communication with patient is in English, with
written evidence from the college principal or dean, it is likely that they can give you an
exemption, provided you havent spent no more than one year after your graduation.

What is next?

Once you achieved 7 in all bands in IELTS according to new rules (please check
www.gmc.org, website regularly for any change in the IELTS score) then you are required to
book exam dates with the GMC.
You need to set up an account with GMC through their website. They require all your
primary medical qualifications (PMQs) and IELTS details. You need to make sure that you are
very clear about the dates of MBBS and internship completion. Mismatch dates only delay
your registration once you pass your PLAB. You can use this account for booking your exam
dates, viewing results and apply for the registration after wards.
There are many centres to prepare for both PLAB parts 1 and 2 in the UK. Theory part i.e.
part 1 can also be self prepared, if you can get hand of good notes from your colleagues or
seniors who have already cleared the tests. There are doctors who have passed PLAB 1
without going to the centres. But for PLAB2, it is recommended that you go to some of the
centres and practise. The main trick to pass these exams is solving as frequently and many
questions as possible.
It is recommended that you also start looking for a clinical attachment placement whilst
preparing for PLAB 2. If you are fortunate enough, get the experience before part 2.

What is clinical attachment?

A clinical attachment is a non-pain attachment to allow exposure to the NHS. It can last for
four to six weeks depending upon the hospital you apply and the consultant you are under
(some consultant are happy to extend your attachment or give posts in other departments,
it is better speak to them after completion).
It is very rare you can get an NHS jobs without prior NHS exposure and a clinical attachment
can fill this gap.
How can you apply for the clinical attachment?

The best way of doing this is to consult your senior who is already working, to know which
places are providing it.
You can also look into different websites of different hospitals. Hospitals normally have a
Human resource department (HR) who help arrange attachments thus should be contacted.
There are a few hospitals and universities who are ready to provide you one. In some
instances, there is a fee contribution for this. Usually it takes 3-4 weeks to get a response
from them.
Before commencing clinical attachment you need to go through a Criminal Record Bureau
(CRB) check and occupational health screening. The health screening is usually done via an
appointment with the hospitals occupational health department and usually consists of
screening for communicable diseases like TB, Hep B,C, HIV, MMR and vaccination status.
They also check your two references. All these pre-employment checks normally take 2- 6
weeks.
The other way of applying for this is to write to the consultant straightway, as many as you
can get hold of and particularly the hospital nearby you. You can get lists of the consultant
and their addresses working in your area in their hospital websites or just googling them.
It is advisable to make a good plan ahead i.e. to apply for it when you are doing PLAB so that
you do not have to wait longer after PLAB 2. Normally people spend 2-3 months just to get a
placement for the attachment. This can be avoided if you are actively looking for it well
ahead. Please bear in mind it is strictly not required to have a GMC registration for doing
clinical attachment, however each trusts varies.
Health Exchange Nepal (HexN) is a charity organisation promoting exchange of medical
knowledge and is happy to provide clinical attachment and support under the HexN PLAB
programmes for PLAB candidates. However it is limited to four candidates a year. Please see
the website (www.hexn.org) for further details.

What to expect in the clinical attachment?

Although this is not a training post, it provides valuable experience for foreign doctors,
helping them, to understand how NHS works.
You need to be proactive during your attachment period as your senior or consultant
has no obligation to teach or guide you. If you are not, then you will not get full
advantage of it.
Request your consultant to be one of your referees as almost all the consultant would
be happy to do that. As you may all agree at some point that this might be very helpful
given that referees from back home respond poorly due to their own various reasons. It
is advisable to have at least three referees on your hand before applying for any NHS
jobs, preferably all from the UK.

History taking, developing communication skills, performing basic clinical procedures

(under observation), clerking patients are the main areas you can explore yourselves and
build up some confidence within whilst at doing attachment. Some trusts clearly
mention to you not to get involved in clinical treatment decision part and please make
sure you abide by their rules.
You can write in your CV or on your experience section in NHS portfolio about your
attachment experiences/appointments.
There is an important place for clinical audit when it comes to get shortlisted for the job.
You can mention about your interest in getting involved in clinical audit or request to
your senior in the ward or your consultant about this. If you manage to get one, it
strengthens your portfolio.

Applying for NHS jobs?

To look for NHS jobs it has own jobsites where you can create an account and add your all
details.
It is really important that you get training posts. These means getting into foundation
programmes run by different deaneries. Foundation year 1 ( FY1 or F1) is equivalent to
internship back home and this is followed by Foundation year 2 (FY2 or F2). This could be
rotator y too in different faculties. Most deaneries have a single annual intake in August,
however the applications for this usually start around September or October the previous
year. See www.foundationprogramme.nhs.uk for further details.
You need to plan ahead whilst you are doing Foundation programmes such as deciding in
which field you are going to pursue after F2. You will then apply for a speciality job which
lasts 2 years (labelled ST1/ST2, CT1/CT2 etc) or more years depending on the speciality.
Some people try and pick specific foundation tracks in order to have more exposure in the
speciality they wish to enter into. All specialities have a royal college (such as the Royal
College of Physicians) and some require you to complete membership exams (e.g. MRCP)
before progressing as a specialist in your 3rd year (ST3 i.e. specialist training 3rd year). Thus, it
is desirable to complete part of your membership (e.g. Part 1) in your foundation years
allowing you to take the remaining parts in ST1 and ST2 as these years can be difficult in
terms of time management.
You can apply for trust jobs, trust locum or service jobs. But in order to help you in future
career and prospects, taking training posts give you more advantage than other posts.
Many hospital or deaneries shortlist candidates on the basis of their CV or form application
or NHS portfolio. It cannot be stressed enough that you should work hard on your CV and/or
application form as this can mean the difference between getting shortlisted or rejected.

Facing an interview?

Once shortlisted, carry all the relevant certificates with you.

Please expect some clinical emergencies case scenarios thrown at you in the interview
related to the posts you are applying for.
It is also good idea to have enough knowledge about clinical audit and its principle and
methodology.
Please make a habit of reading some international journal or some RCT or meta-analysis
presentations from various websites as some of the consultants are fond of asking in this
area. Please visit following for this

http://www.tripdatabase.com/
http://www.ncbi.nlm.nih.gov/pubmed/
http://sumsearch.org/
Please do not get surprised by some of the questions related to Good Medical Practice
outlined by GMC and it is sent out to you in a booklet after you registered with them. It is
also available from the website.
Others frequently asked question is about your previous experiences and qualification and
what are you good at and weak at etc.
It is important to be honest and tell them clearly that you dont know if you do not know the
answer. They like people who can admit their weaknesses rather than people who can give
a false impression.

What else you can do in order to enhance your portfolio to get into NHS?
It is getting more difficult to get into NHS these days as the posts are drying up sooner. This
is partly due to producing enough doctors within the country and surplus of foreign doctors
in the UK. You need to out-stand the crowd or be able to show them that you are proactive.
First of all, a well- written CV or portfolio is really important. This means you reflect about
your experiences as an attach in the ward all the time in your CV or portfolio wherever
possible.
Please make sure you have written documents or Certificates of your experiences wherever
possible.
There are many things you can do after passing PLAB and getting GMC registration number
besides clinical attachment, such as appearing for membership examination into your
subject of interests is one of them.
Some of the membership examinations do not require any prior experience in the UK, such
as the MRCP UK (please visit www.mrcp.org for further details).
Continuous Medical Education (CME) or Continuous Professional Development (CPD) is
another way you can work to get stand out from the rest of the competitors. This can be
found in many websites for free on various interesting topics. You can do as many as
modules you like. You can visit :- http://www.cme-cpd.eu , http://learning.bmj.com for
CME- CPD and registered with them to do their free CME modules. They provide certificates
on completion on each module and you can add these into your training section of your
NHS portfolio and take it with you during your interviews. The credit can also be
transferable later when you have e-portfolio setup when you are doing Foundation
programmes.

So we wish you luck for your career as a doctor in United Kingdom. Although this is a general
idea from many experiences from previous doctors in the UK, it might not work in some cases.
Please feel free to give us some feedback if you find this section helpful at all.

Best of Luck